Epilepsia
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Multicenter Study Clinical Trial
Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: a pharmacokinetic study during whole body hypothermia.
Therapeutic hypothermia has recently been introduced to treat term newborns with hypoxic-ischemic encephalopathy, of whom more than half have seizures. Phenobarbital is widely used to treat neonatal seizures, but it is unknown whether its pharmacokinetics is affected by hypothermia. We evaluated the influence of hypothermia on phenobarbital pharmacokinetics in asphyxiated newborns. ⋯ Phenobarbital administered to newborns under whole body hypothermia results in higher plasma concentrations and longer half-lives than expected in normothermic newborns.
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Editorial Review
Modern antiepileptic drug development has failed to deliver: ways out of the current dilemma.
Despite the development of various new antiepileptic drugs (AEDs) since the early 1990s, the available evidence indicates that the efficacy and tolerability of drug treatment of epilepsy has not substantially improved. What are the reasons for this apparent failure of modern AED development to discover drugs with higher efficacy? One reason is certainly the fact that, with few exceptions, all AEDs have been discovered by the same conventional animal models, particularly the maximal electroshock seizure test (MES) in rodents, which served as a critical gatekeeper. These tests have led to useful new AEDs, but obviously did not help developing AEDs with higher efficacy in as yet AED-resistant patients. ⋯ The failure of AED development has led to increasing disappointment among clinicians, basic scientists, and industry and may halt any further improvement in the treatment of epilepsy unless we find ways out of this dilemma. Therefore, we need new concepts and fresh thinking about how to radically change and improve AED discovery and development. In this respect, the authors of this critical review will discuss several new ideas that may hopefully lead to more efficacious drug treatment of epilepsy in the future.
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To investigate the feasibility of antiepileptic drug (AED) withdrawal following anterior temporal lobectomy (ATL) and to identify the predictors of post withdrawal seizure recurrence. ⋯ AED withdrawal can be safely attempted following successful ATL. Seizure recurrences are few and can be managed easily.
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Status epilepticus (SE) is an important neurologic emergency requiring treatment on an intensive care unit (ICU). Although convulsive SE is self-evident, the diagnosis of nonconvulsive SE (NCSE) depends on electroencephalography (EEG) confirmation. Previous work showed that 82% of patients with SE had NCSE in our ICU. We hypothesize that continuous video-EEG monitoring (CVEM) may increase the diagnostic yield in patients with SE, especially NCSE, and leave fewer patients undiagnosed. ⋯ Frequency of NCSE diagnosis increased significantly after implementation of CVEM and was higher than the increment of performed investigations alone. Such an effect may result from the combination of longer observation periods during CVEM, greater and permanent availability of EEG recordings, and heightened awareness of NCSE. Future studies may corroborate improvement of diagnosis and outcomes in patients with disorders of consciousness by CVEM.
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This retrospective cross-sectional study was carried out to study the association between different levels of hyponatremia and the occurrence of epileptic seizures in patients without a prior epilepsy diagnosis. We identified from the hospital database, 363 inpatients of a Swedish County hospital who between March 2003 and August 2006 were found to have serum sodium levels <125 mM. ⋯ Of 150 patients reviewed with serum sodium levels of 120-124 mM, one had a seizure. Using 120-124 mM as reference, odds ratios (95% confidence interval) for having seizures at serum sodium levels of 115-119 mM was 3.85 (0.40-37.53), 8.43 (0.859-82.85) at 110-114 mM, and 18.06 (1.96-166.86) at <110 mM.